What does the "Medicare-approved amount" mean, and how do I know if my doctor accepts Medicare assignment?
Answered by 3 licensed agents
For most physician services, Medicare sets payment amounts using its fee schedule. Each service has a billing code, and Medicare determines an approved amount based on the service provided and other factors, including geographic differences in healthcare costs.
For example, a doctor might normally charge $200 for a service, but if Medicare's approved amount is $120, Medicare bases its payment and your share on the $120, not the doctor's original $200 charge.
That is where Medicare assignment becomes important.
If your doctor accepts assignment, the doctor agrees to accept Medicare's approved amount as payment in full. After your Part B deductible, Medicare generally pays 80% for many covered services and you pay the remaining 20%.
Doctors who see Original Medicare patients generally fall into three groups:
Accepts assignment: The doctor accepts the Medicare-approved amount as full payment.
Accepts Medicare but not assignment: The doctor can still treat Medicare patients but may be allowed to charge more than the Medicare-approved amount — generally up to 15% more for certain services.
Opted out of Medicare: The doctor does not bill Medicare. You generally pay under a private agreement.
So when calling a doctor's office, don't just ask, “Do you take Medicare?”
Ask: “Do you accept Medicare assignment?”
That tells you much more about what you could actually have to pay.
Answered by Jeremy Harkins on September 23, 2026
Broker Licensed in TN, AR, CA & 5 other states
Answered by Wade Shiu on September 28, 2026
Broker Licensed in SC, AZ, DE & 17 other states
Answered by Michael Brady on October 1, 2026
Broker Licensed in UT, AL, AZ & 6 other states
Tags: Coverage Medicare Part B The Medicare System
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